<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Username')}:</label>
        <div class="col-xs-12 col-sm-8" style="padding-top:7px;">
            {$row.username|htmlentities}
        </div>
    </div>
   
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Coupondata')}:</label>
        <div class="col-xs-12 col-sm-8">
            
            <div class="radio">
            {foreach name="coupondataList" item="vo"}
            <label for="row[coupondata]-{$key|htmlentities}"><input id="row[coupondata]-{$key|htmlentities}" name="row[coupondata]" type="radio" value="{$key|htmlentities}" {in name="key" value="$row.coupondata"}checked{/in} /> {$vo|htmlentities}</label> 
            {/foreach}
            </div>

        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Orderdata')}:</label>
        <div class="col-xs-12 col-sm-8">
            
            <div class="radio">
            {foreach name="orderdataList" item="vo"}
            <label for="row[orderdata]-{$key|htmlentities}"><input id="row[orderdata]-{$key|htmlentities}" name="row[orderdata]" type="radio" value="{$key|htmlentities}" {in name="key" value="$row.orderdata"}checked{/in} /> {$vo|htmlentities}</label> 
            {/foreach}
            </div>

        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Status')}:</label>
        <div class="col-xs-12 col-sm-8">
            
            <div class="radio">
            {foreach name="statusList" item="vo"}
            <label for="row[status]-{$key|htmlentities}"><input id="row[status]-{$key|htmlentities}" name="row[status]" type="radio" value="{$key|htmlentities}" {in name="key" value="$row.status"}checked{/in} /> {$vo|htmlentities}</label> 
            {/foreach}
            </div>

        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
